Provider Demographics
NPI:1962907618
Name:ALAM, STACI HARDY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:HARDY
Last Name:ALAM
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:ANN
Other - Last Name:HARDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7987
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36670-0987
Mailing Address - Country:US
Mailing Address - Phone:251-633-7211
Mailing Address - Fax:
Practice Address - Street 1:5955 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608
Practice Address - Country:US
Practice Address - Phone:251-633-0573
Practice Address - Fax:251-633-7367
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-094441363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL512-11027OtherBCBS
ALZ54594OtherVIVA HEALTH
ALA00613AOtherMEDICARE
AL218235Medicaid
AL219701Medicaid
AL512-10626OtherBCBS
ALP02048503OtherRR MEDICARE
AL6775695OtherUNITED HEALTHCARE
AL6812694OtherAETNA
AL512-11028OtherBCBS OF AL
AL6775695OtherUNITED HEALTHCARE
AL218206Medicaid
AL512-10627OtherBCBS OF AL
ALZ54594OtherVIVA HEALTH
AL218235Medicaid
AL6812694OtherAETNA
ALP02048503OtherRR MEDICARE